Medical card policy - then and now

Here are some key quotes from politicians and health officials as the discretionary medical cards review controversy unfolded and the PR and political sands shifted in recent months:

August 27, 2013 - Junior Health Minister Alex White on the legal issues in extending free GP Care to long-term illness scheme patients: "Basing a person's qualification for a GP service on their having a particular medical condition would be complex from a legal point of view. It could be done, but it would mean further delay and it doesn't make sense to start drafting complicated legislation for this, given that you were only dealing with the first phase of a much bigger, population-wide project (The extension of free GP care)." The following May the Government, facing severe criticism on discretionary medical card reviews, started the process of drafting complex legislation to grant medical cards on medical, rather than on financial grounds alone.

October 30 2013 - Health Minister James Reilly on medical card reviews, as criticism grew about cards being removed from seriously ill people: - "No one who is entitled to a medical card need worry. Despite the significant savings to be made by the HSE in the year ahead, nobody who is entitled to a medical card will lose it or be refused one."

"Today the HSE has provided details of its plan which include; providing extra resources to the national Call Centre for public enquiries, a public information campaign through media advertisements, the development of a key new information leaflet, improved support on the HSE website, wide ranging training for frontline staff and more."

April 6 2014: HSE Director General Tony O'Brien (in an interview with irishhealth.com):"The 1970 Act allows me to operate discretion in terms of granting medical cards, but it has to be done on an even-handed, equitable basis so that people in a similar situation are treated in the same way and for the moment, this financial formulaic approach serves that purpose."

"I'm also concerned that standardised approaches do mean sometimes that people whose individual circumstances haven't changed at all, can on review when judged against a clear rule set, be deemed no longer eligible for a medical card. This can be very difficult for them to understand if their individual circumstances haven't materially changed, but they maybe in the past were granted a medical card in circumstances where they ought not to have been. So we need to be able to look at ways we might be able to deal with those situations in a more sensitive way."

May 11 2014: HSE head of primary care John Hennessy, addressing a GP conference in Galway: "There are some things that have happened (in relation to reviews and withdrawals of discretionary cards for people with serious medical needs) that are clearly indefensible." Mr Hennessy said this type of situation should not be allowed occur in future.

May 12 2014: Media reports say mother of Down Syndrome child was asked to prove her son still had the condition during a medical card eligibility review.

May 22 2014: Kathleen O'Meara, Head of Advocacy and Communications, Irish Cancer Society: "From our National Cancer Helpline and through our Daffodil Centres we are hearing from many cancer patients who are losing their discretionary medical card after a review or who are being refused in the first instance. We have written to the Primary Care Reimbursement Service (PCRS) of the HSE requesting an urgent meeting to discuss the issues arising for cancer patients applying for medical cards or being reviewed."

May 29 2014- Department of Health statement announcing suspension of discretionary card reviews and new system of eligibility for cards: "The Government is very aware of the public concern in relation to the issue of medical cards. The Cabinet Committee on Health met this morning and decided to develop the policy framework governing eligibility in a manner that will also take account of medical conditions."

"The HSE will establish an expert panel to examine the range of conditions that should be brought into consideration. This process will include the development of a new legislative framework as necessary."

"In light of this decision, the HSE Director General will now suspend reviews of medical cards where discretion had been exercised to take account of medical circumstances."

"The Department of Health has also been mandated to develop a policy paper on the further roll-out of GP care free at the point of access in the context of the move to Universal Health Insurance."

June 17, 2014 - Department of Health statement announcing that 15,000 discretionary medical cards that have been withdrawn on review will be returned): "The Government has accepted that the review of the cards - which took place in the context of the centralisation of the medical card system - produced unintended consequences. Much anecdotal evidence points to the fact that some persons with an acute medical condition, or a lifelong condition (including a disability) have lost their medical cards, an outcome that the Government could not stand over."

"In recent weeks the Government decided to take remedial action to repair the unintended consequences and also decided to formulate a new policy whereby eligibility for health services can take account of medical conditions, in addition to the existing basis of financial means."

June 17, 2014 - Health Minister James Reilly at press conference announcing restoration of discretionary cards: " This (the withdrawal of cards) was an unintended consequence of efforts to bring greater efficiency to the PRCS (HSE medical card section) and the processing of medical card applications. The Government realises that this is something that caused tremendous hardship to people. But the PCRS did their job as per the rules at the moment."

"There are people with serious illnesses, serious disability,with terminal illness in some cases and in some cases serious cancers who have lost their medical card and we want to correct that. I am very sorry that they had to suffer this - it was an unintended consequence."